Systemic lupus erythematosus( SLE) is systemic immunological disease. It can bring harm to multiple organs and tissues. When the kidneys are involved, it is called Lupus Nephritis. In history, Lupus Nephritis is divided into six classes. As follows:
ClassⅠ: Minimal Mesangial Lupus Nephritis
The glomeruli are roughly normal under light microscopy. The urinalysis is typically normal. Howeverm the mesangial deposits are noted in electron microscopy.
ClassⅡ: Mesangial Proloferative Lupus Nephritis
The light microscopy presents mesangial cells proliferation and matrix expansion. By immunofluorescence, IgG and/or IgM, c3c4 can be seen to deposit in mesangial area. In some cases, the patients may have microscopic hematuria with or without proteinuria. In this class, high blood pressure and Nephrotic Syndrome etc are rare.
ClassⅢ: Focal Lupus Nephritis
Focal Lupus Nephritis is noted by sclerotic lesions of < 50% of the glomeruli and segmental mesangial cells proliferation. In electron microscopy, subendothelial deposits are noted. Immunofluorescence reveals IgG, IgA, IgM, C3, and C1q in mesangial area and capillary walls. In clinic, hematuria and proteinuria is present with or without Nephrotic Syndrome, high blood pressure, and increased creatinine.
ClassⅣ: Diffuse Lupus Nephritis
It is the most common Lupus Nephritis. Approximately half of glomeruli are involved which can be segmental or global with mesangial or endothelial cells proliferation. Immunofluorescence reveals IgG, IgA, IgM, C3, and C1q in mesangial area and capillary walls. Clinically, hematuria and proteinuria is present, frequently with Nephrotic Syndrome, hypertension and elevated creatinine.
ClassⅤ: Membranous Lupus Nephritis
It is similar to Primary Membranous Nephritis. Meanwhile, it is featured by mesangial and endothelial cells proliferation. IgG, IgA, IgM, C3, and C1q deposit in capillary walls from immunofluorescence.
ClassⅥ: Advancing Sclerosing Lupus Nephritis
More than 90% of the glomeruli are sclerous. This stage is clinically observed as slowly progressive renal dysfunction.
The class of Lupus Nephritis is not stable. Uncontrolled, the disease will advance into next class. Therefore, the patients should receive treatment as early as possible to stop renal function decline.
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